How to Get What You Want from the Pediatrician

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Doctor, Teacher, Therapist, Friend Pediatrics is probably the happiest branch of medicine. Medical students choose it because they love children, and most seasoned pediatricians will tell you that the joy of working with youngsters still holds up 30 years into their careers. In addition to being cute and generally endearing, children tend to recover quickly and come down with serious illnesses far less often than adults. If doctors like to succeed, the chances of doing so are much greater in pediatrics than in any other field of medicine. Perhaps because of this, 69 percent of all medical residents plan on becoming pediatricians. What this means for parents is that there are a lot of enthusiastic, talented pediatricians who would love to serve your family.

Behind the Scenes: Multitasking and Loving It Children's health care used to be about treating severe communicable diseases such as polio, scarlet fever, diphtheria, and smallpox. All that changed during the last half of the twentieth century, when vaccinations for most of these diseases were developed. Today, health issues are only a part of the pediatrician's territory. "So much of what we do is, for lack of a better term, social work/ mental health care," says Margaret Fitzgerald, a family nurse practitioner in Lawrence, Massachusetts, and founder of Fitzgerald Health Education Associates. Parents count on pediatricians not just for health matters but also for advice about discipline, learning disabilities, social problems, sibling rivalry, custody conflicts, and much more. Writer and pediatrician Perri Klass notes that "parents these days often look to pediatricians to provide the sort of expertise that once was given by a resident grandparent or neighboring aunt." While an adult wouldn't dream of asking her doctor how to solve a problem she was having at work, parents rely on pediatricians to help them solve problems with school bullies, homework, testing anxiety, and a whole range of other school issues. Guidance counselor, grandma, physician, behavioral therapist, and education specialist  today's pediatrician is expected to fill all these roles, and for the most part she cheerfully complies.

Parents aren't the only ones who expect a lot out of pediatricians. The police expect them to be on the lookout for physical and sexual abuse. Schools expect them to help educate teenagers about substance abuse and sex. The American Academy of Pediatrics expects them to provide "anticipatory guidance" for parents, which means informing them about every conceivable childhood safety issue, including but not limited to seat belts, bike helmets, sleep position, nonflammable pajamas, scooters, drowning, lead screening, gun safety, television viewing, and of course, sex, drugs, and smoking. Finally, pediatricians are under pressure from HMOs and insurance companies to provide rapid, cost-effective services. The typical pediatrician sees 28 children a day; the average yearly checkup lasts 15-20 minutes, and a sick-child visit lasts 10.

Despite all the demands, pediatricians are for the most part a willing and passionate group. They readily acknowledge that they aren't just treating children, they are treating families, and they seem eager to step up to the plate even though medical school rarely prepares them for the challenge. Says pediatrician Andrew Baumel of Framingham, Massachusetts: "Training in mental health is definitely deficient. You learn a lot on the job." Most of that learning has to do with how to talk to parents. Baumel's biggest surprise when he became a pediatrician was that "everyone has an advocate. In other areas of medicine, you're dealing with one person who has a problem, but in pediatrics we always have two people for every issue: the patient, who is frequently over two and verbal, and the parent, stepparent, grandparent, et cetera. So we're always dealing with at least two people, and sometimes four or five." Twenty years ago, doctors often resented parents who asked too many questions. Today, everyone agrees that children's health is a family affair, and for pediatricians that means knowing how to talk  and listen  to parents. More than other doctors, they welcome your input and are tolerant of your anxieties.

However, even the most virtuous pediatricians can be pushed to their limits by overly demanding, careless, or inconsiderate parents. And because pediatricians receive the same basic medical training as all doctors, they have some of the same biases: they value calm voices, clarity, and facts, and are turned off by too much emotion and vague information. (First-time mothers get a free pass on neurotic overworrying and general cluelessness until the child is about two; then most pediatricians expect them to calm down.) To get the best out of your pediatrician, begin by learning the basics they wish every parent understood.

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